Counterpoint: NSAIDs for Fractures – More Harm Than Good?

Written by Clay Smith

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NSAID use >72 hours may contribute to delayed long bone fracture healing or nonunion in adults.

Why does this matter?
Pain control after a fracture is important, but avoiding opioids when possible to reduce the risk of long term use or misuse is also important. NSAIDs are good for relieving pain, but do they negatively impact fracture healing?

If it’s not broke…oh wait actually it is
This is a counterpoint to yesterday’s post. These authors argue that NSAIDs interrupt the inflammatory process needed for fracture healing. They note that previous evidence suggests a dose and duration dependent effect on delayed healing or non-union, especially with long bone fractures and NSAID use over 72 hours. There are some randomized studies and observational data that raise concerns. The quality of meta-analyses to address this is suspect due to conflicting results, significant heterogeneity, and failure to adjust for known confounders for fracture healing, such as diabetes and smoking. However, these authors conclude that the overall weight of the evidence strongly suggests that for tibial shaft, humerus, existing non-union, spinal fracture requiring fusion, comminuted, or unstable fractures, the risk of using NSAIDs longer than 72 hours is a significant contributor to delayed healing or non-union and should be avoided.

Source
Non-steroidal Anti-inflammatory Drug Use for More Than 72 hours in Adult Long-Bone Fractures: The Risks Outweigh the Benefits. Ann Emerg Med. 2020 Nov;76(5):676-678. doi: 10.1016/j.annemergmed.2019.08.457.

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